Placebo Effect Rivals Steroid Benefit for Asthmatics

Never underestimate the power of the mind when it comes to feeling better.

In the newest demonstration of how healing can be triggered by patients' expectations of what medical attention can do for them, placebo treatments were as good as real medication in making asthmatic patients feel they were breathing more easily.

Thirty-nine asthma patients reported about as much perceived relief from a placebo inhaler or from sham acupuncture as from an inhaled dose of the steroid albuterol, according to results of a pilot study published Wednesday in The New England Journal of Medicine.

In the study, the asthmatic patients were randomly rotated through four different "treatments" at four appointments spaced several days apart: some inhaled albuterol, some used an inhaler containing no medication, some underwent sham acupuncture treatment and others had no treatment at all.

When asked how they felt, the study participants, mostly women, reported 50 percent improvement from inhaled albuterol, 46 percent improvement following the sham acupuncture and 45 percent improvement from the placebo inhaler, compared with 21 percent improvement when they underwent breathing tests but received no treatment. More than two-thirds of the time, the researchers reported, patients felt as if they were getting an active treatment, even when they weren't.

However, objective measurements of the patients' lung capacity in the two hours following each of the sessions found that albuterol helped their lungs push out 20 percent more air, while the other treatments only produced a 7 percent increase in lung capacity.

"Placebo effects can be clinically meaningful and can rival the effects of active medication in patients with asthma," Dr. Michael E. Wechsler, a specialist in asthma and other lung diseases at Brigham and Women's Hospital and Harvard Medical School in Boston, and his study co-authors wrote. They said their study differed from previous studies of placebo effects because they included a comparison group that received no treatment at all, which "allowed us to detect subjective placebo effects." They noted that "the mere ritual of treatment may affect patients' self-monitoring and subjective experience of their disease."

At the same time, though, they said that when it comes to managing and treating men and women with asthma, "patient self-reports can be unreliable."

In an accompanying editorial in the same issue of the journal, Daniel E. Moerman, an expert on the placebo effect at the University of Michigan-Dearborn, questioned the conclusion that patients' self-reports were unreliable because their perceived improvements from placebo treatments weren't supported by the lung tests. He suggested doctors need to give greater weight to how patients feel, not just what tests show. "It is the subjective symptoms that brought these patients to medical care in the first place. They came because they were wheezing and felt suffocated, not because they had a reduced [lung capacity]," said Moerman, author of the 2002 book "Meaning, Medicine and the 'Placebo Effect.'"

When it comes to such conditions as migraine, schizophrenia, back pain, depression, asthma, post-traumatic stress and neurological disorders, which are often defined by their symptoms, Moerman said patients' feelings about what helps them feel better "trump the judgment of the physician." In those cases, he wrote, dummy pills "can be as useful as 'real' ones."

Much of what convinces patients that a treatment is working stems from the meaning they invest in medical procedures and technology, as well as the "power and authority" they associate with white coats or uniforms, Moerman said. All of these have "power, regardless of what may be in the capsule or syringe."

A study published Monday in the Annals of Family Medicine found that the placebo effect reduced the duration of common colds. University of Wisconsin researchers compared the effects of four treatments on 700 newly diagnosed cold sufferers. Some received dummy pills; others, pills containing the herbal remedy echinacea. Some got echinacea pills without their knowledge, and some got nothing at all.

On average, colds were slightly shorter and symptoms milder among patients taking any pill compared to those getting nothing. Among study participants who were the strongest believers in echinacea's power to ease colds, any pill made their colds last 2.5 fewer days, again reflecting the power of mind over body.